Influence of folic acid and vitamin B12 supplementation on arsenic methylation: A double-blinded, placebo-controlled trial in Bangladeshi children

BACKGROUND

Inorganic arsenic is metabolized to monomethyl- (MMAs) and dimethyl- (DMAs) species via one-carbon metabolism (OCM); this facilitates urinary arsenic elimination. OCM is influenced by folate and vitamin B12 and previous randomized control trials (RCTs) showed that folic acid (FA) supplementation increases arsenic methylation in adults. This RCT investigated the effects of FA + B12 supplementation on arsenic methylation in children, a key developmental stage where OCM supports growth.

METHODS

A total of 240 participants (8-11 years, 53 % female) drinking from wells with arsenic concentrations > 50 μg/L, were encouraged to switch to low arsenic wells and were randomized to receive 400 μg FA + 5 μg B12 or placebo daily for 12-weeks. Urine and blood samples were collected at baseline, week 1 (only urine) and week 12. Generalized estimated equation (GEE) models were used to assess treatment effects on arsenic species in blood and urine.

RESULTS

At baseline, the mean ± SD total blood and urinary arsenic were 5.3 ± 2.9 μg/L and 91.2 ± 89.5 μg/L. Overall, total blood and urine arsenic decreased by 11.7% and 17.6%, respectively, at the end of follow up. Compared to placebo, the supplementation group experienced a significant increase in the concentration of blood DMAs by 14.0% (95% CI 5.0, 25.0) and blood secondary methylation index (DMAs/MMAs) by 0.19 (95% CI: 0.09, 0.35) at 12 weeks. Similarly, there was a 1.62% (95% CI: 0.43, 20.83) significantly higher urinary %DMAs and -1.10% (95% CI: -1.73, -0.48) significantly lower urinary %MMAs in the supplementatio group compared to the placebo group after 1 week. The direction of the changes in the urinary %iAs, %MMAs, and %DMAs at week 12 were consistent with those at week 1, though estimates were not significant. Treatment effects were stronger among participants with higher baseline blood arsenic concentrations. Results were consistent across males and females, and participants with higher and lower folate and B12 status at baseline.

CONCLUSION

This RCT confirms that FA + B12 supplementation increases arsenic methylation in children as reflected by decreased MMAs and increased DMAs in blood and urine. Nutritional interventions may improve arsenic methylation and elimination in children, potentially reducing arsenic toxicity while also improving nutritional status.

Development of an HPLC-PDA Method for the Simultaneous Estimation of Three Antibiotics in Pharmaceutical Formulations and Bovine Milk and Health Risk Assessment

A simple new, rapid, sensitive, and cost-effective HPLC-PDA method was developed and validated for the determination of tetracycline (TC), oxytetracycline (OTC), and ciprofloxacin (CIP) simultaneously. Chromatographic separations were carried out using a reversed-phase Shim-pack GIS C18 column (4.60 × 250.00 mm; 5.00 µm) at 30°C. Oxalic acid (0.05 M), acetonitrile, and methanol were used as mobile phase under gradient elution conditions at the flow rate of 1.50 mL min-1. Detection wavelength was set at 330 nm. An aliquot of 20.00 µL solution was injected, and three drugs were eluted within 7.39 ± 0.05 min. As per ICH guidelines linearity, recovery, accuracy, precision, selectivity, specificity, sensitivity, stability, column efficiency, system suitability, and robustness were determined for the validation of the proposed method. Calibration curves were linear over a studied concentration range of 8.00 µg mL-1 with a correlation coefficient (r) of 0.999 for all drugs. Relative standard deviation (RSD) for intra- and interday precision was found less than 2.87% and 3.22%, respectively, indicating the method to be reproducible. The proposed method has been suitably applied for the estimation of TC, OTC, and CIP in pharmaceutical formulation and milk samples collected from local market in Bangladesh. Among 15 milk samples analyzed, most of the cases (more than 50%) TC, OTC, and CIP were detected above maximum residue levels (MRLs) though no significant toxicological effect on the health of consumers in the study area was identified.

Selection of lansoprazole from an FDA-approved drug library to inhibit the Alzheimer's disease seed-dependent formation of tau aggregates

The efficacy of current treatments is still insufficient for Alzheimer's disease (AD), the most common cause of Dementia. Out of the two pathological hallmarks of AD amyloid-β plaques and neurofibrillary tangles, comprising of tau protein, tau pathology strongly correlates with the symptoms of AD. Previously, screening for inhibitors of tau aggregation that target recombinant tau aggregates have been attempted. Since a recent cryo-EM analysis revealed distinct differences in the folding patterns of heparin-induced recombinant tau filaments and AD tau filaments, this study focused on AD seed-dependent tau aggregation in drug repositioning for AD. We screened 763 compounds from an FDA-approved drug library using an AD seed-induced tau aggregation in SH-SY5Y cell-based assay. In the first screening, 180 compounds were selected, 72 of which were excluded based on the results of lactate dehydrogenase assay. In the third screening with evaluations of soluble and insoluble tau, 38 compounds were selected. In the fourth screening with 3 different AD seeds, 4 compounds, lansoprazole, calcipotriene, desogestrel, and pentamidine isethionate, were selected. After AD seed-induced real-time quaking-induced conversion, lansoprazole was selected as the most suitable drug for repositioning. The intranasal administration of lansoprazole for 4 months to AD seed-injected mice improved locomotor activity and reduced both the amount of insoluble tau and the extent of phosphorylated tau-positive areas. Alanine replacement of the predicted binding site to an AD filament indicated the involvement of Q351, H362, and K369 in lansoprazole and C-shaped tau filaments. These results suggest the potential of lansoprazole as a candidate for drug repositioning to an inhibitor of tau aggregate formation in AD.

Elements in cultured fishes in Chittagong, Bangladesh and risk assessment

The concentrations of manganese, iron, copper, lead, nickel, cadmium, arsenic, copper and mercury were determined in 10 cultured fish species, which were collected from local markets of Chittagong, Bangladesh, in June 2021. Measurements were performed by atomic absorption spectrophotometry, after acid digestion of the samples. In some cases, the concentration of the investigated elements was more than the maximum limit set by the WHO. Although the concentration of toxic elements in fishes was relatively high in some species, no health risk has been identified in comparison to the estimated daily intake and the maximum limit. Calculated hazard indices were below 1, which indicates the investigated fish would not cause human health risks. Carcinogenic risk indices for Cr, As, and Cu in all species were considered to be significant.

Arsenic exposure is associated with alterations to multiple red blood cell parameters among adults in rural Bangladesh

Chronic arsenic exposures are associated with multiple hematologic disturbances, including anemia. The goal of this study was to evaluate associations between arsenic exposures and hematological parameters among men and women who are chronically exposed to elevated levels of arsenic from drinking water. Hematologic analyses were performed on blood collected from 755 participants (45% male and 54% female) in the Health Effects of Arsenic Longitudinal Study (HEALS) cohort, Bangladesh. Herein, we used linear regression models to estimate associations between red blood cell (RBC) parameters (i.e., RBC counts, hematocrit (HCT), hemoglobin (Hgb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC)) and measurements of arsenic exposure (urinary arsenic and urinary arsenic metabolites). Arsenic exposures showed trending associations with decreased RBC counts in both men and women, a positive association with MCV in males, and an inverse association with MCHC among males, but not among non-smoking females. Among men, those who smoked had stronger associations between arsenic exposures and MCHC than non-smoking males. Collectively, our results show that arsenic exposures affect multiple RBC parameters and highlight potentially important sex differences in arsenic-induced hematotoxicity.

Troponin I Elevation after Elective Percutaneous Coronary Interventions: Prevalence and Risk Factors

Percutaneous coronary intervention (PCI) is one of the most important modalities of treatment for coronary artery disease (CAD). Minor extents of injury to the myocardium have been observed even after successful PCI. This peri-procedural injury might therefore reduce some of the beneficial effects of coronary revascularization. The objective of this hospital based comparative observational study was to determine the prevalence of post procedural Cardiac troponin I (cTnI) elevation after elective PCI and also to find out the relation with risk factors such as age, sex, body mass index (BMI), smoking, anemia, diabetes mellitus, hypertension, dyslipidemia, family history, left ventricular dysfunction, renal insufficiency, type of stent, number of stent and length of stent. This was a hospital based comparative observational study carried out in the Department of Cardiology, Chattogram Medical College Hospital (CMCH), Chattogram, Bangladesh from July 2018 to June 2019. A total of 50 patients who underwent elective PCI were included as sampled by purposive sampling method. Serum cTnI was measured by FIA8000 quantitative immunoassay analyzer with an analytical measurement before and at 24 hours of PCI. Value >1.0ng/ml was considered elevated. Univariate and multivariate analysis were applied to assess predictors for the occurrence of post-procedural elevation of cTnI. The mean±SD age of the study population was 54.96±9.1 years (range 35-74 years) and 34(68.0%) patients were male. Regarding cardiovascular risk factors, 17(34.0%) patients had diabetes mellitus, 27(54.0%) had dyslipidemia, 30(60.0%) had hypertension, 32(64.0%) were current or ex-smokers and 20(40.0%) had a family history of CAD. Eighteen patients (36.0%) had post-procedural cTnI elevation but only 8(16.0%) had significant (>1.0ng/ml) elevation. Change of cTnI before and at 24 hours of PCI was not significant (p=0.057). Cardiac Troponin I increase was related to age, pre-procedural serum creatinine and multi-vessel stenting. Minor elevation of cTnI was common following elective PCI and associated with few risk factors such as elderly patient (more than 50 years), raised serum creatinine and multi-vessel stenting. So, early detection of these risk factors, as well as effective intervention may help to prevent injury to cardiac tissue hence stop elevation of cardiac TnI following elective PCI.

Comparison of clinical outcomes and biochemical markers in normal and preeclamptic pregnancies: a prospective cohort study

Background

Preeclampsia (PreE), the de novo onset of hypertension and proteinuria at 20 weeks of gestation, is a leading cause of maternal and fetal morbidity and mortality. This study compared inflammatory biomarkers in PreE and normal pregnancies using paired samples of mothers and neonates.

Methods

Twenty normal pregnant and 27 PreE patients were monitored for biomarkers, neonatal outcomes, and placental morphologies. Fetal and maternal serum levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble endoglin (sENG), and soluble fms-like tyrosine kinase-1 (sFLT-1) were measured by enzyme-linked immunosorbent assay.

Results

Placental thickness was 25 mm in early PreE subjects compared to 32 mm in late PreE subjects (P < 0.05). Placental volume was 296 cm3 in early PreE compared to 393 cm3 in late PreE (P < 0.05). The average hospital stay for PreE babies was longer (20 ± 5 days) compared to babies from normal pregnancies (2 ± 1 days; P < 0.05). PreE babies had a lower Ponderal index (2.28 ± 0.3) than those from normal pregnancies (2.95 ± 0.2; P < 0.05). sENG and sFLT-1 had cord values like the maternal values, while VEGF and PlGF did not.

Conclusion

PreE alters the intrauterine environment by activating chemical mediators that result in maternal and fetal complications.

Antimicrobial Resistance of E Coli Causing Urinary Tract Infection in Bangladesh

Rapid spread of multidrug resistant microorganisms is a matter of great concern throughout the glove including Bangladesh. The objective was to identify the causative organisms for urinary tract infection (UTI) and their sensitivity patterns to antibiotics. This descriptive cross-sectional study was conducted on patients admitted with UTI (n=60) at a tertiary level hospital in Dhaka, Bangladesh from March 2019 to September 2019. Data were collected through clinical record reviews. Data of all these 60 cases were analyzed for socio-demographic characteristics. Of the 60 patients, culture and sensitivity report was available for 42 patients. Therefore, data were further analyzed for these 42 cases. Median age of patients was 35 years and 80% were female. The main organisms isolated from urine culture of UTI patients were E. coli (64%), Klebsiella (12%) and Enterococci species (10%). Susceptibility to antibiotics was analyzed only for E. coli (n=27) since the number of isolates of other organisms were small. E. coli was found to be resistant to most of the first- and second-line antibiotics, such as Amoxicillin (100%), Amoxyclav (72%), Co-trimoxazole (89%), Nalidixic acid (78%), Ceftazidim (94%), Ceftriaxone (73%), Cefuroxime (100%), Ciprofloxacin (59%), Cephotaxime (80%), Cefixime (100%) and Moxifloxacin (100%). E. coli was the predominant organism responsible for UTI and was resistant to most of the first- and second-line antibiotics. Immediate action is needed to develop empirical guideline for empirical management of UTI and establish surveillance system for monitoring.

Modulation of the sublingual microenvironment and pH-dependent transport pathways to enhance atropine sulfate permeability for the treatment of organophosphates poisoning

Atropine sulfate (AS) auto-injectors are the only approved antidote for out-of-hospital emergency treatment of organophosphates (OP) toxicity. However, they are only available for military use and require the administration of multiple auto-injectors. Therefore, an alternative, patient-friendly and more affordable fast-disintegrating sublingual tablets (FDSTs) of AS were previously developed. In this article, the effect of modifying the microenvironment's pH and/or using penetration enhancers on AS sublingual transport pathways were evaluated in an attempt to further enhance AS sublingual permeability. Ten different AS FDST formulations with or without the incorporation of alkalizer and various penetration enhancers were manufactured and characterized. AS permeability was investigated through excised porcine sublingual membrane using Franz cells. Results showed that the incorporation of either a transcellular enhancer or alkalizer achieved a significantly higher AS permeability enhancement (twofold). Combining sodium bicarbonate (Na Bicarb) 2% as alkalizer with sodium dodecyl sulfate (SDS) 1% as a transcellular enhancer resulted in the greatest synergistic enhancement in AS sublingual permeability (up to twelvefold). In conclusion, the modified AS FDST developed in this work has the potential to improve the pharmacokinetic parameters of AS following sublingual administration for the first-aid treatment of OP toxicity in future animal bioequivalency studies.

Cartiotonic steroids affect monolayer permeability in lymphatic endothelial cells

Edema is common in preeclampsia (preE), a hypertensive disorder of pregnancy. Cardiotonic steroids (CTSs) such as marinobufagenin (MBG) are involved in the pathogenesis of preE. To assess whether CTSs are involved in the leakage of lymphatic endothelial cell (LEC), we evaluated their effect on monolayer permeability of LECs (MPLEC) in culture. A rat mesenteric LECs were treated with DMSO (vehicle), and CTSs (MBG, CINO, OUB) at concentrations of 1, 10, and 100 nM. Some LECs were pretreated with 1 μM L-NAME (N-Nitro-L-Arginine Methyl Ester) before adding 100 nM MBG or cinobufotalin (CINO). Expression of β-catenin and vascular endothelial (VE)-cadherin in CTS-treated LECs was measured by immunofluorescence and MPLEC was quantified using a fluorescence plate reader. Western blot was performed to measure β-catenin and VE-cadherin protein levels and myosin light chain 20 (MLC20) phosphorylation. MBG (≥ 1 nM) and CINO (≥ 10 nM) caused an increase (p < 0.05) in the MPLEC compared to DMSO while ouabain (OUB) had no effect. Pretreatment of LECs with 1 μM L-NAME attenuated (p < 0.05) the MPLEC. The β-catenin expression in LECs was downregulated (p < 0.05) by MBG and CINO. However, there was no effect on the LECs tight junctions for the CINO group. VE-cadherin expression was downregulated (p < 0.05) by CINO, and MLC20 phosphorylation was upregulated (p < 0.05) by MBG. We demonstrated that MBG and CINO caused an increase in the MPLEC, which were attenuated by L-NAME pretreatment. The data suggest that CTSs exert their effect via nitric-oxide-dependent signaling pathway and may be involved in vascular leak syndrome of LEC lining in preE.

Association between body mass index and arsenic methylation in three studies of Bangladeshi adults and adolescents

BACKGROUND

Water-borne arsenic (As) exposure is a global health problem. Once ingested, inorganic As (iAs) is methylated to mono-methyl (MMA) and dimethyl (DMA) arsenicals via one-carbon metabolism (OCM). People with higher relative percentage of MMA (MMA%) in urine (inefficient As methylation), have been shown to have a higher risk of cardiovascular disease and several cancers but appear to have a lower risk of diabetes and obesity in populations from the US, Mexico, and Taiwan. It is unknown if this opposite pattern with obesity is present in Bangladesh, a country with lower adiposity and higher As exposure in drinking water.

OBJECTIVE

To characterize the association between body mass index (BMI) and As methylation in Bangladeshi adults and adolescents participating in the Folic Acid and Creatine Trial (FACT); Folate and Oxidative Stress (FOX) study; and Metals, Arsenic, and Nutrition in Adolescents Study (MANAS).

METHODS

Arsenic species (iAs, MMA, DMA) were measured in urine and blood. Height and weight were measured to calculate BMI. The associations between concurrent BMI with urine and blood As species were analyzed using linear regression models, adjusting for nutrients involved in OCM such as choline. In FACT, we also evaluated the prospective association between weight change and As species.

RESULTS

Mean BMIs were 19.2/20.4, 19.8/21.0, and 17.7/18.7 kg/m² in males/females in FACT, FOX, and MANAS, respectively. BMI was associated with As species in female but not in male participants. In females, after adjustment for total urine As, age, and plasma folate, the adjusted mean differences (95% confidence) in urinary MMA% and DMA% for a 5 kg/m² difference in BMI were -1.21 (-1.96, -0.45) and 2.47 (1.13, 3.81), respectively in FACT, -0.66 (-1.56, 0.25) and 1.43 (-0.23, 3.09) in FOX, and -0.59 (-1.19, 0.02) and 1.58 (-0.15, 3.30) in MANAS. The associations were attenuated after adjustment for choline. Similar associations were observed with blood As species. In FACT, a 1-kg of weight increase over 2 to 10 (mean 5.4) years in males/females was prospectively associated with mean DMA% that was 0.16%/0.19% higher.

DISCUSSION

BMI was negatively associated with MMA% and positively associated with %DMA in females but not males in Bangladesh; associations were attenuated after plasma choline adjustment. These findings may be related to the role of body fat on estrogen levels that can influence one-carbon metabolism, e.g. by increasing choline synthesis. Research is needed to determine whether the associations between BMI and As species are causal and their influence on As-related health outcomes.

Strain-specific clearance of seed-dependent tau aggregation by lithium-induced autophagy

Different conformational strains of tau have been implicated in the clinicopathological heterogeneity of tauopathies. In this study, we hypothesized that distinct strains are degraded in a different manner. Lithium, a drug for bipolar disorder, had previously been reported to reduce aggregation-prone protein content by promoting autophagy. Here, we assessed the effects of lithium on tau aggregates using different tauopathy brain seeds. SH-SY5Y cells were transfected with C-terminal tau fragment Tau-CTF24 (residues 243-441), and Alzheimer's disease (AD), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) brain seeds were introduced. After 48-h lithium treatment, sarkosyl-insoluble fractions were prepared. Lithium treatment was found to reduce the amount of insoluble tau and p62, and increase LC3-II levels along with the number of autophagic vacuoles in AD-seeded cells. The effects were lower in case of CBD seeds, and comparable between PSP and AD seeds. An inhibitor of myo-inositol monophosphatase (IMPase) also demonstrated similar effects. Overall, the study suggested that aggregated tau protein is degraded by lithium-induced autophagy, influencing IMPase in a strain-specific manner.

The Role of Oxidative Stress and Its Counteractive Utility in Colorectal Cancer (CRC)

An altered redox status accompanied by an elevated generation of reactive oxygen/nitrogen species (ROS/RNS) has been implicated in a number of diseases including colorectal cancer (CRC). CRC, being one of the most common cancers worldwide, has been reported to be associated with multiple environmental and lifestyle factors (e.g., dietary habits, obesity, and physical inactivity) and harboring heightened oxidative stress that results in genomic instability. Although under normal condition ROS regulate many signal transduction pathways including cell proliferation and survival, overwhelming of the antioxidant capacity due to metabolic abnormalities and oncogenic signaling leads to a redox adaptation response that imparts drug resistance. Nevertheless, excessive reliance on elevated production of ROS makes the tumor cells increasingly vulnerable to further ROS insults, and the abolition of such drug resistance through redox perturbation could be instrumental to preferentially eliminate them. The goal of this review is to demonstrate the evidence that links redox stress to the development of CRC and assimilate the most up-to-date information that would facilitate future investigation on CRC-associated redox biology. Concomitantly, we argue that the exploitation of this distinct biochemical property of CRC cells might offer a fresh avenue to effectively eradicate these cells.

Titanium (IV) complexes of some tetra-dentate symmetrical bis-Schiff bases of 1,6-hexanediamine: Synthesis, characterization, and in silico prediction of potential inhibitor against coronavirus (SARS-CoV-2)

Symmetrical bis‐Schiff bases (LH₂) have been synthesized by the condensation of 1,6‐hexanediamine (hn) and carbonyl or dicarbonyl. One of the synthesized Schiff bases has been subjected to the molecular docking for the prediction of their potentiality against coronavirus (SARS‐CoV‐2). Molecular docking revealed that tested Schiff base possessed high binding affinity with the receptor protein of SARS CoV‐2 compared with hydroxychloroquine (HCQ). The ADMET analysis showed that ligand is non‐carcinogenic and less toxic than standard HCQ. Schiff bases acting as dibasic tetra‐dentate ligands formed titanium (IV) complexes of the type [TiL(H₂O)₂Cl₂] or [TiL(H₂O)₂]Cl₂ being coordinated through ONNO donor atoms. Ligands and complexes were characterized by the elemental analysis and physicochemical and spectroscopic data including FTIR, ¹H NMR, mass spectra, UV‐Visible spectra, molar conductance, and magnetic measurement. Optimized structures obtained from quantum chemical calculations supported the formation of complexes. Antibacterial, antifungal, and anti‐oxidant activity assessments have been studied for synthesized ligands and complexes.

A Novel Formulation Strategy to Deliver Combined DNA and VLP Based HPV Vaccine

Human papillomaviruses (HPV) are small, double-stranded DNA viruses that cause cervical cancer, the second most lethal cancer among women in the world. Currently, two vaccines are on the market for preventing HPV-caused cervical cancers and warts. Both are virus-like particle (VLP)-based vaccines. However, these vaccines have limitations; they are costly, have an invasive route of administration, require trained personnel to administer, need cold chain storage to preserve them, and most of all, they are preventive vaccines that do not have curative effects. Therefore, it is necessary to develop therapeutic HPV vaccines to facilitate the control of HPV-associated malignancies and to address all these issues. Recently there are DNA vaccines under investigation to prevent HPV. In general, DNA-based vaccines are better than or an excellent alternative to traditional vaccines since they can closely mimic live infections and can induce both antibody and cell-mediated immune responses. DNA vaccines involve the delivery of plasmid DNA (pDNA) which encodes the specific antigens. DNA vaccines have potential to be effective therapeutic tools against HPV infections. Combining the VLP-based and DNA-based vaccines can be highly effective as they can complement each other. VLP vaccines are more prone to mucosal immunity whereas DNA vaccines are more towards systemic immunity. In this article, we discuss an optimal formulation that will contain both type of vaccines, preventive and therapeutic. A film dosage form can be a good option which can be administered in buccal or sublingual routes for systemic action or in the vaginal area for local action to treat cervical cancer and to protect from future infection. Multiple vaccines in native form or in particulate form can be incorporated in film dosage forms. The film dosage form of vaccines can elicit both antibody-mediated (preventative) and cell-mediated (therapeutic) mechanisms. Film dosage forms are feasible to prepare for vaccine administration in the mouth cavity, GI tract, and vagina.

Overview and Future Potential of Fast Dissolving Buccal Films as Drug Delivery System for Vaccines

Vaccination is considered one of the most successful public health interventions of the modern era. Vaccines are categorized based on the antigen used, delivery system and the route of administration. Traditional vaccines are produced from the dead, attenuated or inactivated pathogens that cause disease. However, newly developed vaccines are DNA based, liposome based, and virus like particle (VLP) based which are more effective and specific to some malignant diseases. The delivery system of vaccines has been advanced along with time as well. New delivery systems such as nanoparticles, liposomes, or cells (for DNA) has been proven to develop a more efficient vaccine. Most vaccines are administered via intramuscular (IM), subcutaneous (SQ) or oral (PO) route. However, these routes of administration have limitations and side effects. An alternative route could be oral cavity administration such as buccal or sublingual administration using film dosage form as delivery vehicle. In this article, we thoroughly reviewed the possibility of developing a quickly soluble film-based delivery system for vaccine administration. We reviewed the different types of new vaccines and vaccine formulations such as VLP based, liposome, bilosome, particulate, and summarized their suitability for use in a film dosage form. Quickly soluble film dosage form is the most optimized form of buccal administration. A film dosage form applied in the buccal cavity has several advantages: they can avoid first pass effect, they are easy to administer and prepare, and they are more cost effective. Since there is no first pass effect, only a small quantity of the vaccine is needed. Vaccines in their original form or in a nano or microparticulate form can be used in a film. The film can also be developed in multilayers to protect the vaccine from degradation by saliva or swallowing. Films are easy to prepare, administer, and can be used for systemic and local action. In addition, most of the current vaccines use mostly the parenteral route of administration, which has some major drawbacks such as poor induction of mucosal immunity, less patient compliant, less potent, high cost and cumbersome production process. Sublingual and buccal vaccine delivery can be good alternatives as they are easier to prepare and safer than parenteral administration routes. The buccal and sublingual administration have the advantage to produce both systemic and mucosal immunity.

Drinking Water Salinity, Urinary Macro-Mineral Excretions, and Blood Pressure in the Southwest Coastal Population of Bangladesh

Background

Sodium (Na⁺) in saline water may increase blood pressure (BP), but potassium (K⁺), calcium (Ca²⁺), and magnesium (Mg²⁺) may lower BP. We assessed the association between drinking water salinity and population BP.

Methods and Results

We pooled 6487 BP measurements from 2 cohorts in coastal Bangladesh. We used multilevel linear models to estimate BP differences across water salinity categories: fresh water (electrical conductivity, <0.7 mS/cm), mild salinity (electrical conductivity ≥0.7 and <2 mS/cm), and moderate salinity (electrical conductivity ≥2 and <10 mS/cm). We assessed whether salinity categories were associated with hypertension using multilevel multinomial logistic models. Models included participant‐, household‐, and community‐level random intercepts. Models were adjusted for age, sex, body mass index (BMI), physical activity, smoking, household wealth, alcohol consumption, sleep hours, religion, and salt consumption. We evaluated the 24‐hour urinary minerals across salinity categories, and the associations between urinary minerals and BP using multilevel linear models. Compared with fresh water drinkers, mild‐salinity water drinkers had lower mean systolic BP (−1.55 [95% CI: −3.22–0.12] mm Hg) and lower mean diastolic BP (−1.26 [95% CI: −2.21–−0.32] mm Hg) adjusted models. The adjusted odds ratio among mild‐salinity water drinkers for stage 1 hypertension was 0.60 (95% CI: 0.43–0.84) and for stage 2 hypertension was 0.56 (95% CI: 0.46–0.89). Mild‐salinity water drinkers had high urinary Ca²⁺, and Mg²⁺, and both urinary Ca²⁺ and Mg²⁺ were associated with lower BP.

Conclusions

Drinking mild‐salinity water was associated with lower BP, which can be explained by higher intake of Ca²⁺ and Mg²⁺ through saline water.

See Editorial Bispham and Nowak

Potential Application of Ionic Liquids in Pharmaceutical Dosage Forms for Small Molecule Drug and Vaccine Delivery System

Ionic liquids are salts in which the ions are poorly coordinated, which causes them to exist in liquid form below 100°C, or at room temperature. Therefore, these are also defined as room temperature ionic liquids (RTILs). In ionic liquids, at least one ion has a delocalized charge and one component is organic, which prevents the formation of a stable solid form of crystal lattice. Physical properties of ionic liquids, such as melting point, viscosity, and solubility of starting materials and other solvents, are impacted by the substituents on the organic component and by the counterions. Many ionic liquids have even been developed to address specific synthetic problems and that is the reason these are also termed as "designer solvents". Ionic liquids are considered as “green solvents” that exhibit several unique characteristics such as high ionic conductivity, high solvation power, thermal stability, low volatility, and recyclability. Although very useful with several advantages, ionic liquids have some limitations that include high cost and ease of recycling. Moreover, the toxicity and biodegradability of ionic liquids are not yet well understood. Nonetheless, ionic liquids can potentially be used in the field of pharmacy in drug design and formulation development. In drug or vaccine dosage formulation development, ionic liquids can be used as a solubility enhancer, permeability enhancer, stabilizer, targeted delivery inducer, stealth property provider or bioavailability enhancer. In this article we reviewed the physical properties of ionic liquids and potential application of ionic liquids in developing formulations for vaccines and small molecule drugs (A table has been added).

Childhood Adversities as Risk Factors and Persistence of Suicidal Behavior: A Descriptive Cross-Sectional Study

Suicide is one of the important cause of death worldwide. The precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour are not well understood. A descriptive cross sectional study was carried out in the department of Psychiatry, Cumilla Medical College, Cumilla, Bangladesh. All cases were selected from patients attending at Cumilla Medical College hospital and Private Hospitals in Cumilla City from April 2017 to September 2018. We found out the association between childhood adversities and suicidal behaviour over the life course and delineated the types of suicidal behavior. Total 120 cases were included in the study. Respondents provided socio-demographic and diagnostic information, childhood adversities as well as an account of suicide-related thoughts and behaviours. A participation rate was 77.5% female. Of 120 suicidal behavior participants physical abuse was 2.5%, sexual abuse was 16.67%, parental death was 5%, parental divorce was 2.5%, other parental loss was 4.17%, family violence was 5%, physical illness was 1.67%, financial adversity was 3.33% and composite adversity was 59.16%. Among childhood adversities participants suicidal ideation was 70%, suicidal plans was 15.83%, suicidal attempts was 45%, ideators only proceeded to plans was 22.5%, ideation to attempt was 63.33%, planned attempts was 10.83% and impulsive attempts was 52.5%. Among suicidal behavior participant's psychiatric disorders were 65%. Where neurotic disorders were 17%, psychotic disorders were 13%, personality disorders were 44% and others disorder was 26%. Most of the suicidal behavior patients were female 77.5% and age group of 18-24 years. Childhood sexual abuse emerged as a particularly robust risk factor for suicide attempts in younger participants. Childhood physical and sexual abuse emerged as risk factors for the emergence and persistence of suicidal behaviour, especially in adolescence. Two or more childhood adversities were associated with a three fold higher risk of lifetime suicide attempts. Childhood adversities are main risk factors for the onset and persistence of suicidal behaviour. The risks being are the greatest in childhood, adolescence and early adult. A longitudinal follow-up study is required to give a more reliable in Bangladesh.

Microplastic contamination in Penaeid shrimp from the Northern Bay of Bengal

Microplastic pollution has received increased attention recently due to potential threat to marine biota and human health. This study reports microplastic (MP) content in brown shrimp (Metapenaeus monocerous) and tiger shrimp (Penaeus monodon) inhabiting in the shallow and offshore waters of the Northern Bay of Bengal, Bangladesh. Gastrointestinal tract (GT) of shrimps (n = 150) were examined for MPs following alkali digestion, microscopic observation and chemical analysis by micro-Fourier Transformed Infrared Spectroscope (μFTIR). A total of 33 and 39 MP items were found in P. monodon and M. monocerous, averaging 3.40 ± 1.23 and 3.87 ± 1.05 items/g GT, respectively. Among various shapes, types and colours of MP, filament (57-58%), fiber (32-57%) and black (48-51%) were dominant amongst the various particles identified. Tiger shrimp had high numbers (23 items) of larger size fractions of MPs (1-5 mm) but brown shrimp had high numbers (15 items) of smaller MPs (250-500 μm), and μ-FTIR data confirmed 13 particles of polyamide-6 and 6 particles of rayon polymers. These results provide a baseline of MP contamination in seafood from Bangladesh that should be useful for future monitoring efforts.

Microplastics in fishes from the Northern Bay of Bengal

Microplastics were determined in pink Bombay-duck (Harpadon nehereus), white Bombay-duck (H. translucens) and gold-stripe sardine (Sardinella gibbosa) collected from the Northern Bay of Bengal at Bangladesh. Gastrointestinal tracts of fishes (n = 25 per species) were examined for microplastics following alkali digestion protocol, microscopic observations and chemical analysis by micro-Fourier Transformed Infrared Spectroscope (μ-FTIR). A total of 443 microplastic items were found in the intestines of H. nehereus, H. translucens and S. gibbosa, averaging in the range of 3.20-8.72 items per species. Among various shapes, colours and types of microplastics, irregular (37-43%), white/transparent (26-68%) and fiber (50-55%) were dominant. The size fraction of microplastics ranging between 1 μm and 5 mm was 68-84 items/kg biomass, and μ-FTIR analysis identified 13 particles of polyethylene terephthalate and 66 particles of polyamide. The study findings raised concern that microplastics in marine fish could be a threat to public health via the food chain.

Optimization of structures, biochemical properties of ketorolac and its degradation products based on computational studies

BACKGROUND

Ketorolac (KTR) is used as an analgesic drug with an efficacy close to that of the opioid family. It is mainly used for the short term treatment of post-operative pain. It can inhibit the prostaglandin synthesis by blocking cyclooxygenase (COX).

METHODS

In this investigation, the inherent stability and biochemical interaction of Ketorolac (KTR) and its degradation products have been studiedon the basis of quantum mechanical approaches. Density functional theory (DFT) with B3LYP/ 6-31G (d) has been employed to optimize the structures. Thermodynamic properties, frontier molecular orbital features, dipole moment, electrostatic potential, equilibrium geometry, vibrational frequencies and atomic partial charges of these optimized structureswere investigated. Molecular docking has been performed against prostaglandin H2 (PGH2) synthase protein 5F19 to search the binding affinity and mode(s). ADMET prediction has performed to evaluate the absorption, metabolism and carcinogenic properties.

RESULTS

The equilibrium geometry calculations support the optimized structures. Thermodynamic results disclosed the thermal stability of all structures. From molecular orbital data, all the degradents are chemically more reactive than parent drug (except K3). However, the substitution of carboxymethyl radicalin K4 improved the physicochemical properties and binding affinity. ADMET calculations predict the improved pharmacokinetic and non-carcinogenic properties of all degradents.

CONCLUSION

Based on physicochemical, molecular docking, and ADMET calculation, this study can be helpful to understand the biochemical activities of Ketorolac and its degradents and to design a potent analgesic drug.

Anti-Phospholipid Antibody Syndrome with Subdural Hematoma: A Case Report

A 33-year-old man with anti-phospholipid antibody syndrome associated with Budd Chiari syndrome and subdural hematoma. He developed venous thrombosis in his hepatic vein (stenting done) when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT). Subdural hematoma demonstrated with Computed tomography (CT) of brain. Laboratory studies revealed thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely antiphospholipid antibodies. Based on these findings, we consider that the tendency of this bleeding may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Antiphospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction and on anticoagulant (warfarin).Pulse Vol.10 January-December 2017 p.25-28

Wound Coverage of Infected Open Fracture of Distal Third of Tibia by Distally Based Medial Hemi-Soleus Muscle Flap

We conducted a study to evaluate the reliability of the medial hemi-soleus muscle flap for wound coverage of infected open fracture of distal third of tibia. Wound coverage of exposed lower third tibia and ankle region remains a difficult task. Muscle flaps are preferred for infected wounds especially where there are exposed bone, joint and/or tendons. Soleus muscle is a good option for local reconstruction. Soleus being the prime ankle plantar flexor and stabilizer of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. So, medial hemisoleus muscle flap is a superior option than the whole Soleus. This post-intervention prospective study which was descriptive in nature was conducted at department of Orthopedics, Community Based Medical College Hospital, Mymensingh, Bangladesh from January 2012 to December 2012. Ten patients with distal third tibial defects were included in the study. Data was obtained by history taking, observation, clinical examination, supported by routine laboratory and radiological investigations. Before intervention they underwent to careful vascular study of the affected limb through Doppler ultrasonography. All the patients were provided soft tissue coverage with distally based medial hemi-soleus muscle flaps with split thickness skin graft on it. All the flaps survived with primary healing of the wound. Among the participants there were 7 male and 3 female with average age 44.60 years, SD 13.73 years. Eight patients were injured by road traffic accident and 2 patients had history of alleged assault. The wound size defects in primary site ranged from 4cm to 9cm in length and 3cm to 6.5cm in breadth. All the wounds in the primary site were infected. The fractures in the primary site were open fractures involving distal third of tibia. In the secondary site the injuries were fracture upper third tibia in the other lower limb 2, fracture femur on other lower limb 1, dislocation shoulder joint on the same side upper limb 1. The follow up period ranged from 8-16 weeks (average 12 weeks). The outcome was successful. All flaps survived without complication. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of distal third of leg. It does not sacrifice the whole soleus muscle. Due to its longer arc of rotation, this flap can cover the defect of different size and shape in distal third of leg.

Diabetes and pre-eclampsia affecting pregnancy: a retrospective cross-sectional study

The interaction between pre-eclampsia and diabetes mellitus (DM) is far from being completely understood. In this study, we compared normal pregnancies with those complicated with pre-eclampsia, gestational DM, and/or pre-existing diabetes to assess the effects of hyperglycemia on placental development. AnInstitutional Review Board (IRB) approved retrospective cross-sectional study with 621 subjects was performed. Statistical analysis was performed using Duncan's post hoc test and analysis of variance. Regardless of diabetes status, patients with pre-eclampsia delivered prematurely. Patients in the group with pre-eclampsia and pregestational diabetes delivered much earlier, at 35.0±0.4 weeks, when compared with the patients that had pre-eclampsia with gestational diabetes and pre-eclampsia with no diabetes (*P<0.05 for each). Additionally, patients with pre-existing diabetes who developed pre-eclampsia delivered smaller babies than those with pre-existing diabetes without pre-eclampsia (1.00±0.03, P<0.05 for each). Pre-existing diabetes with added insult of pre-eclampsia led to fetal growth restriction. This outcome validates the understanding that elevated glucose earlier in pregnancy alters placentogenesis and leads to fetal growth restriction.

Aerobic Exercise Training as a Potential Cardioprotective Strategy to Attenuate Doxorubicin-Induced Cardiotoxicity

Doxorubicin is one of the most commonly used cytotoxic anticancer drugs against several cancers.  Although a highly effective anticancer drug, the clinical use of doxorubicin is severely limited by its cardiotoxicity which results in morbidity, poor quality of life, and premature mortality.  Only very few clinically accepted methods to minimize doxorubicin-induced cardiac injury are available today, but none of them have proven to be completely successful.  Due to limited alternative strategies, a number of potential cardioprotective therapies are currently being investigated for treating and/or preventing doxorubicin-induced cardiotoxicity.  Of these potential strategies, aerobic exercise training is the only nonpharmacologic strategy that shows a great deal of promise.  Although there are no published human clinical trials, evidence from numerous animal studies suggests that aerobic exercise training, administered prior to, during and/or following doxorubicin therapy, is protective against doxorubicin-induced cardiac injury.  Protective properties of exercise training against the cardiotoxicity of doxorubicin have been attributed to a number of potential molecular mechanisms including:  enhancing the production of endogenous antioxidant machineries; regulating proapoptotic signaling; stimulating the release, mobilization and homing of cardiac progenitor cells; limiting myocyte turnover; eliciting favorable adaptations in myocardial calcium handling and preventing calcium overload; modulating cardiac AMPK activity; downregulating cardiac autophagy/lysosomal signaling; and reducing myocardial doxorubicin accumulation.  Further preclinical and clinical research is needed to decipher and refine the molecular mechanisms underlying the cardioprotective effects of exercise training, as well as to define the nature and magnitude of the effect of exercise on doxorubicin-induced cardiotoxicity in cancer patients. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Increased Indoleamine 2,3-Dioxygenase and Quinolinic Acid Expression in Microglia and Müller Cells of Diabetic Human and Rodent Retina

Purpose

We investigated the relationship between inflammation, neuronal loss, and expression of indoleamine 2, 3-dioxygenase (IDO) and quinolinic acid (QUIN) in the retina of subjects with type 1 diabetes (T1D) and type 2 diabetes (T2D) and in the retina of rats with T1D.

Methods

Retinas from T1D (n = 7), T2D (n = 13), and 20 age-matched nondiabetic human donors and from T1D (n = 3) and control rats (n = 3) were examined using immunohistochemistry for IDO, QUIN, cluster of differentiation 39 (CD39), ionized calcium-binding adaptor molecule (Iba-1, for macrophages and microglia), Vimentin (VIM; for Müller cells), neuronal nuclei (NeuN; for neurons), and UEA1 lectin (for blood vessels).

Results

Based on morphologic criteria, CD39⁺/ionized calcium binding adaptor molecule 1(Iba-1⁺) resident microglia and CD39⁻/Iba-1⁺ bone marrow–derived macrophages were present at higher density in T1D (13% increase) and T2D (26% increase) human retinas when compared with controls. The density and brightness of IDO⁺ microglia were increased in both T1D and T2D human retinas. The intensity of QUIN⁺ expression on CD39⁺ microglia and VIM⁺ Müller cells was greatly increased in both human T1D and T2D retinas. T1D retinas showed a 63% loss of NeuN⁺ neurons and T2D retinas lost approximately 43% when compared with nondiabetic human retinas. Few QUIN⁺ microglia-like cells were seen in nondiabetic retinas, but the numbers increased 18-fold in T1D and 7-fold in T2D in the central retina. In T1D rat retinas, the density of IDO⁺ microglia increased 2.8-fold and brightness increased 2.1-fold when compared with controls.

Conclusions

Our findings suggest that IDO and QUIN expression in the retinas of diabetic rats and humans could contribute to the neuronal degeneration that is characteristic of diabetic retinopathy.

Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale

INTRODUCTION

Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh.

METHODS AND ANALYSIS

The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants.

ETHICS AND DISSEMINATION

The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT02746003; Pre-results.

Psychiatric Disorders in Drop out from Educational Attainment Attending Mental Health Facilities: A Descriptive Cross Sectional Study

Studies of the impact of mental disorders on educational attainment are rare. Mental disorders, those beginning in childhood or adolescence may increase the risk of early drop out from education. The latter has been shown to have adverse life-course consequences on individuals such as greater demand on social welfare entitlements. A descriptive cross sectional study was carried out at the department of Psychiatry, Comilla Medical College, Comilla, Bangladesh. All cases were selected from patients attending at Comilla Medical College Hospital and Private Mental Health Facilities in Comilla City from March 2015 to February 2016. We found out the psychiatric disorders and socio-demographic status of patients with educational drop out over the early life course. A total of 50 dropout patients aged 10 to 30 years who fullfiled the enrolment criteria included in the study. Sociodemographic questionnaires, diagnostic information (DSM-5 and ICD-10) as well as an account of a various level of education were used as research instruments. The Frequency tables, summary tables and appropriate graphs were prepared to describe the population characteristics and study finding. The most of the psychiatric morbidity presents in male (62%) and age group of 18-24 years (54%). In this study, anxiety disorders was 8%, behaviour/ impulse control disorders was 8%, mood disorders was 16%, substance use disorders was 24%, schizophrenia spectrum disorders was 12% and composite psychiatric disorders was 32%. Among drop out patient's non- completion of primary education was 14%, non-completion of secondary education was 20%, non- completion of higher secondary education was 24%, not entry to tertiary education was 12% and non-completion of tertiary education was 30%. Among behaviour/impulse control disorders non-completion of primary education was 6%, substance use disorders non-completion of higher secondary education was 10%, mood disorder both non-completion of higher secondary education and non-completion of tertiary education were 6%. Among composite psychiatric disorders non-completion of secondary education, non-completion of higher secondary education and non-completion of tertiary education were 8%, 6% and 12% respectively. Onset of mental disorders and subsequent drop out from education was found in this study. Further multi-centered prospective and population-based studies should be designed to find out the exact situation.

Site-1 protease is required for the generation of soluble (pro)renin receptor

The extracellular domain of the (pro)renin receptor [(P)RR] is cleaved to generate the soluble form of (P)RR [s(P)RR]. Multiple clinical studies have revealed the association between serum/plasma s(P)RR levels and certain diseases, thereby suggesting a potential role for s(P)RR as a disease biomarker. Here, we investigated whether site-1 protease (S1P) is responsible for cleaving (P)RR to generate s(P)RR. Reduction of endogenous S1P with siRNA attenuated s(P)RR generation in Chinese hamster ovary (CHO) cells exogenously expressing human (P)RR with a C-terminal decahistidine tag [CHO/h(P)RR-10His cells]; conversely, overexpression of S1P by transient transfection increased s(P)RR generation. The S1P inhibitor PF429242 suppressed s(P)RR generation in CHO/h(P)RR-10His and human cervical carcinoma HeLa cells; however, the ADAM inhibitor GM6001 had no effect. The furin inhibitor Dec-RVKR-CMK had no effect on the amount of s(P)RR, but caused a slight increase in the size of the s(P)RR. Moreover, the reversible vesicle-trafficking inhibitor brefeldin A (BFA) enhanced the generation of large-sized s(P)RR; PF429242, but not Dec-RVKR-CMK, suppressed this BFA-induced s(P)RR formation. The size of s(P)RR generated during BFA treatment was reduced after removal of BFA; Dec-RVKR-CMK, but not PF429242, suppressed this conversion. Together, these results suggest that s(P)RR is generated by sequential processing by S1P and furin.

Synthetic Receptors Induce Anti Angiogenic and Stress Signaling on Human First Trimester Cytotrophoblast Cells

The cytotrophoblast (CTB) cells of the human placenta have membrane receptors that bind certain cardiotonic steroids (CTS) found in blood plasma. One of these, marinobufagenin, is a key factor in the etiology of preeclampsia. Herein, we used synthetic receptors (SR) to study their effectiveness on the angiogenic profile of human first trimester CTB cells. The humanextravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. Culture media of CTB cells treated with ≥1 nM SR level revealed sFlt-1 (Soluble fms-like tyrosine kinase-1) was significantly increased while VEGF (vascular endothelial growth factor) was significantly decreased in the culture media (* p < 0.05 for each) The AT₂ receptor (Angiotensin II receptor type 2) expression was significantly upregulated in ≥1 nM SR-treated CTB cells as compared to basal; however, the AT₁ (Angiotensin II receptor, type 1) and VEGFR-1 (vascular endothelial growth factor receptor 1) receptor expression was significantly downregulated (* p < 0.05 for each). Our results show that the anti-proliferative and anti-angiogenic effects of SR on CTB cells are similar to the effects of CTS. The observed anti angiogenic activity of SR on CTB cells demonstrates that the functionalized-urea/thiourea molecules may be useful as potent inhibitors to prevent CTS-induced impairment of CTB cells.

Aerobic Exercise Training as a Potential Cardioprotective Strategy to Attenuate Doxorubicin-Induced Cardiotoxicity

Doxorubicin is one of the most commonly used cytotoxic anticancer drugs against several cancers.  Although a highly effective anticancer drug, the clinical use of doxorubicin is severely limited by its cardiotoxicity which results in morbidity, poor quality of life, and premature mortality.  Only very few clinically accepted methods to minimize doxorubicin-induced cardiac injury are available today, but none of them have proven to be completely successful.  Due to limited alternative strategies, a number of potential cardioprotective therapies are currently being investigated for treating and/or preventing doxorubicin-induced cardiotoxicity.  Of these potential strategies, aerobic exercise training is the only nonpharmacologic strategy that shows a great deal of promise.  Although there are no published human clinical trials, evidence from numerous animal studies suggests that aerobic exercise training, administered prior to, during and/or following doxorubicin therapy, is protective against doxorubicin-induced cardiac injury.  Protective properties of exercise training against the cardiotoxicity of doxorubicin have been attributed to a number of potential molecular mechanisms including:  enhancing the production of endogenous antioxidant machineries; regulating proapoptotic signaling; stimulating the release, mobilization and homing of cardiac progenitor cells; limiting myocyte turnover; eliciting favorable adaptations in myocardial calcium handling and preventing calcium overload; modulating cardiac AMPK activity; downregulating cardiac autophagy/lysosomal signaling; and reducing myocardial doxorubicin accumulation.  Further preclinical and clinical research is needed to decipher and refine the molecular mechanisms underlying the cardioprotective effects of exercise training, as well as to define the nature and magnitude of the effect of exercise on doxorubicin-induced cardiotoxicity in cancer patients. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Histological and Cytological Correlation of Cervical Cancer and Precancerous Lesions in a Tertiary Hospital in Bangladesh

Over 500,000 new cases of cervical cancer are diagnosed each year in the world, resulting in 250000 deaths. Prevalence of HPV-related cervical carcinoma in Bangladesh is highest among SAARC countries. In Bangladesh very few studies have been published on establishing the correlation between histological and cytological findings on cervical cancer and precancerous lesions. This descriptive cross-sectional study was performed to find out the correlation between histological & cytological findings of cervical cancer and precancerous lesions. In the present study, cervical smears were collected from the selected patients attending the colposcopy clinic of BSMMU from July 2011 to April 2013. Biopsy was done on colposcopically positive cases and histopathological reports were obtained. Thus 99 histologically proven cases of cervical cancer and precancerous lesion were selected. Pap smear was carried out on these 99 samples after histopathological examination. Among the 60 CIN-1 cases in histology, 18(30%) cases were diagnosed positive by Pap smear; out of 20 histologically diagnosed cases of CIN-II, only 12(60%) cases were correctly diagnosed by cytology. But in case of invasive squamous cell carcinoma 18 out of 19 were correctly diagnosed by Pap smear reaching a concordance rate of 94.74%. Overall the relation reached statistical significance (p<0.05). Larger community based studies are required in this respect to find a consistent correlation between hr-HPV load and cervical cancer and precancerous lesions.